Numbers registered on the Central Treatment List: 1994 - 2009
Current Services and Numbers attending
6 Drug Treatment Centres, 1 Mobile Clinic and a Central Pharmacy
13 Satellite Clinics.
CTL: August 2010 : 2040 methadone patients attending with 1997 registered at the end of this period. 7 new cases registered.
Waiting List: 9
584 (n= 39) Total: 1716 541 (n=25) 591 (29 Pharmacies) Community Pharmacists: 93 285 Total: 935 453 197 Attending GPs: (65 GPs: Level 2: 18, Level 1: 47) 493 916 631 Attending DTCs, satellite clinics etc. Dublin North East Dublin North Central Dublin North West LHO Area
Graph 1. Illustrates the number of Service Users attending the DTC’s (Drug Treatment Centres) in the different area HSE. Total: 1370
Graph 2. Illustrates the number of Service Users attending the Satellite Clinics. Total: 643
The Drug Treatment Centre Board
Dual Diagnosis / Co-morbid Psychological morbidity: Anxiety and depressive disorders, PTSD, Personality Disorders. Psychotic Disorders, Major Mental Illness
Challenging and aggressive behaviours
Service provision for areas not covered in the community by DTCs / Satellite Clinics
Young Person’s Programme
Numbers attending the DTCB, September 2010 2 229 249 Total 0 74 81 F 2 155 168 M Summary Total 0 39 43 Total North East 0 9 10 f LHO Dublin 0 30 33 M 8 1 104 114 Total Central 0 33 37 f LHO Dublin 1 71 77 M 7 1 86 92 Total North West 0 32 34 f LHO Dublin 1 54 58 m 6 New End of period During Period Gender CCA
Primary Care Services: Level 1 and 2 GPs, Community Pharmacies
Specialist Multidisciplinary Teams:
Drug Treatment Clinics, Satellite clinics, DTCB
Inpatient Residential Services
Inpatient Drug Treatment Units: Cuan Dara / St.Michaels Ward, Beaumount Hospital.
Client Referral and Pathways: Drug Treatment Clinic in the community Service User: Opiate / Cocaine Initial Assessment: Nurse, Counsellor, GP, CWO, Urinalysis Discussion at clinical team meeting: Referrals to other members of the team and external referrals Referral to Other HSE Addiction Rehabilitation Services: Talbot Centre, Soilse. Residential Inpatient + Rehabilitation Services Referrals: Self, Family +Friends, GPs, Social Services, Statutory, Community Services, Outreach, Prisons, Hospitals, Psychiatric services, Maternity Services Referral to other services: i.e. SASSY Team, Addiction Psychiatry MDT Team: GPs, Nurse, Counsellors, Consultant Psychiatrist, Rehabilitation Integration Service, Outreach, CWO, Hepatitis C Nurse, Liaison Mid-wife, Sen.GA, Pharmacists
“ Menu of Services”
Medications / Substitution Treatments. Maintenance and detoxification programmes
Viral screening and vaccinations,.
Comprehensive Psychiatric assessment and Treatment Plan
Counselling and evidence based counselling interventions.
Psycho-Social and Rehabilitation
Rehabilitation Integration Services: Comprehensive assessment and Care –plan: Focusing on rehabilitation i.e. training schemes, CEE schemes, accommodation issues, support in preparation for detoxification and residential treatment and rehabilitation.
CWO: in 1 LHO area: Advising on benefits and advocating for clients in being able to access benefits.
Greater need for family involvement
Client Referral and Pathway: Soilse: Rehabilitation Day Programme: Goals: Stabilisation of Drug Use and Detoxification. Service User Team + Activities: Keyworker, Educators, counsellors, Career Guidance, Literacy, Health+Fitness, Art, Drama, creative pursuits Comprehensive assessment: Appointed Key worker and development of Care-plan. Preparation for detoxification, Personal development. 1:1 and Group work Interagency Working Rehabilitation Integration Services, residential drug treatment units and residential rehabilitation Units. Partnership: Soilse: Rutland Referral: Self, rehabilitation Integration Services, Treating clinic team, Probation etc as per treatment clinic .
The Talbot Centre: is a dedicated Prevention service for children, young people and their families whose lives have been affected by drugs / alcohol in the North Inner City. Client / Service User/ Family Team: 1 Education Officer, Project Leaders x 2 (1WTE) 3 Project Workers Comprehensive assessment Allocated Keyworker and development of Care-Plan Collaboration, Interagency Working. Case -management Educational: Prevention Advocacy, Counselling, Family Therapy, Outreach Referrals: Family, community groups, SASSY Team, Social Workers, Crinian Project, JLOs. Courts, residential Care Centres, Family Support Network, LDTFs
S.A.S.S.Y. ( S ubstance A buse S ervice S pecific to Y outh ) Team
1 psychiatrist + 0.6 counsellor
Lack of staff severe
Cover all North Dublin city & county
Assess and treat all U-18 drug and /or alcohol users from catchment area (all drugs)
Do not need to be drug free to attend
Assess mental health
Offer 1:1 psychotherapy
Medication if required
Advise re risky behaviours
CBT / MI approach
Worked with 136 last year
1 prison clinic per week
2 sessions at YPP DTCB
Advice & education role- often country wide via phone
High risk groups in care
Early intervention for tomorrow’s problems
Inpatient Drug Treatment Units: Beaumount Hospital and Cuan Dara, Cherry Orchard Hospital
Maintain on methadone maintenance
Detox. from other drug / alcohol use
Detoxification Programmes :
Detoxification from Methadone 40mg / 50mg
Has attended for counselling and has aftercare plan
St.Michael’s Ward: 4 weeks
Cuan Dara: 6 weeks: 3 weeks medical detoxification, 3 weeks Drug Free
1:1 Counselling, Group Work
Keltoi: HSE Residential Rehabilitation Unit: Drug Free, 8 Week Programme: Service User Comprehensive assessment process: Pre-admission group and urinalysis: Drug Free Team and Supports: Manager, Keyworkers, residential care workers, counsellors, family therapy, catering tutor (vacant),CWO, Educational supports: VEC, Literacy, Fitness, gardening. Allocated Keyworker and development of care-plan: Living Skills and capacity building Referrals: Self, Residential detoxification Units, Rehabilitation Day Programmes, Rehabilitation Integration Services and clinical teams, Community GPs Aftercare: 2 years, 1:1 counselling. Supportive housing / step down facilities, Day Programmes. Ongoing liaison with other services
Keltoi: Residential Drug Free Rehabilitation Unit.
Feb. 2001 to Dec. 2009.
Total admissions: 414 , Total completed treatment: 314
Total No. of assessments: 1278
Since 2007: 90% Completion rate
Outcomes at 1-3 years and compared to other research.
60% free of all drugs except alcohol between 1 and 3 years 41% free of all drugs except alcohol at 1 year 23% free of opiates at 2-3 years Outcomes Keltoi (Residential rehabilitation n=85) Rosie Study (Residential rehabilitation nationally: N=81) Smyth et. al. (n=113, Cuan Dara, inpatient detoxification unit) Research
Drug Treatment Clinics:
Development of a Comprehensive assessment Key Worker assigned Development of a care plan.
Case Manager and case management if required.
Greater Interagency Working grounded by Interagency Protocols
National Drug Rehabilitation Implementation Committee: Framework Document Aftercare Transition Programmes (e.g. structured pre-induction) Budgeting & Money Management Family Support & Childcare Justice, Law and Criminal Issues Support Education & Training, Personal Development Housing & Tenancy Support & independent Living Community Integration, Social & Recreational Activities Employment (including community employment), Work Placements General Health Services, Health Promotion, Mental, Physical and Intellectual Disability etc Drug Specific Interventions Service User
Change of Philosophy
Negative Public Image of services
Changing Needs of Service Users
Financial Pressures and pressures of the Moratorium
Homeless Strategy and impact on services
Reconfiguration of Services
Aims of Services
To support Service users in services based in their locality and at a Tier that meets their needs.
To promote stabilisation and detoxification and transfer of service users to primary care services.